Implementing Physical Distancing in the Hospital: A Key Strategy to Prevent Nosocomial Transmission of COVID-19

Perhaps the biggest challenge is how many clinical workrooms in hospitals today are crowded with computers next to each other. Ventilation can also be poor, making conditions riskier. This makes implemention of social distancing extremely challenging, but also critical, given how much time hospital-based clinicians spend on computers and in their workrooms. The first step to achieving social distancing in the workroom is to take an inventory of how many people work there and get a log of the number of computers. Consider whether existing computers can be rearranged with a goal of keeping people 6 feet apart. For particularly cramped workrooms, this may require assigning computer spaces to physicians across a floor or several floors, using computers out on a unit, or using mobile computers to limit the number of people in the workroom at one time. We suggest working with physical plant leaders and Information Technology to reallocate mobile workstations, laptops, or desktops to conference rooms, patient visiting areas, and offices that are not being used. Because coronavirus can survive on surfaces for several hours, it is also important to stock work rooms with disinfectants to clean surfaces such as keyboards and desktops frequently. One other important thing to consider is whether computers can be assigned to specific teams or people to limit the use of a computer by multiple people.

Rounding

Perhaps one of the most fundamental hardships with physical distancing is how to conduct routine clinical care such as rounds, sign-out, or multidisciplinary rounds. Rounds on teaching services are particularly challenging given the number of people. At many teaching institutions, medical students are no longer on clinical rotations, which immediately reduces the number of people on teaching teams. The other thing to consider is how rounds are conducted. As opposed to a large team walking together, assign one person from the team as the liaison for the patient, which also has the added benefit of conserving precious PPE. Virtual rounding enables clinicians, including residents and attendings, to work together and decide the plan for the day without first crowding into a patient room. This is perhaps the most important cultural hurdle that one may face.

Another administrative hurdle and common concern is how to bill for such interactions. While federal guidance evolves, our institution created smartphrases for this type of virtual rounding whereby attendings attest to resident notes even if they did not physically see the patient. Additional information may be obtained from patients by calling them on their patient-room phones or by using telemedicine as some hospitals are implementing.³ For large “mega” teams, split the team into smaller groups to facilitate continuity and easier conversations.

Sign-out

When feasible, it is important to transition to phone sign-out supplemented with viewing an updated shared sign-out, ideally electronically, for shift change. When using phone sign-out, it is ideal to implement a verbal read-back to ensure understanding and to keep your sign-out updated. Because using the telephone is not the most effective communication channel for sign-out, it is key to be vigilant with other sign-out best practices, such as using a standard template like IPASS⁴ or another framework, prioritizing sick patients, and ensuring a focus on to-do and if/then items that are critical for the receiver to ensure understanding.⁵